It was also feared that unworthy and worthy, the rich and the poor, all were susceptible to the fevers and plagues that were carried throughout the air. And so in New York City, the observers of the conditions found that disease, debasement, and pauperism—that is, disease, immorality, and poverty—were the major threats to the healthy conditions of the city. Throughout the city, dirty streets, clogged sewers, polluted wells were commonplace.

As a result of all this garbage and stench and filth in New York City, epidemics of infectious diseases were commonplace. In the 19th and early 20th centuries, there were four outbreaks of cholera in New York, where more than 5,000 residents died in 1849. Smallpox epidemics waxed and waned over the century, as did typhoid, typhus, malaria, yellow fever, pneumonia, diphtheria, and tuberculosis. I bet many of those things we don't even recognize their names anymore, they have so much disappeared from our landscape.

In 1881 and 1887, nearly 5,000 residents died of diphtheria, while typhoid accounted for thousands of deaths in 1864 and '65. The influenza epidemic in 1918 killed 12,562 persons in one year alone. And one of the most disturbing statistics was the large number of infants and young children who died of diarrhreal diseases, especially in the summer. In 1840, approximately 190 of every 1,000 infants born in New York City never reached their first birthdays. By 1930, however, fewer than 70 in 1,000 infants born in New York City died in the first year of life. Young adults also faced harsh conditions. In 1840 and 1870, nearly one-quarter of those reaching the age of 20 would not live to the age of 30.

Many of the diseases that caused all these deaths thrived in the dirty water, unpasteurized milk, and untreated sanitation and deplorable housing conditions that were the normal conditions of life for most of New York's inhabitants, especially its poorest inhabitants. It is also important to realize, in the deaths of children and youth, that because epidemic diseases took so many of these from these groups during this period, the expectation of many parents was that their children would not live. Generally people thought that one or two of their children would probably die before they reached the age of 5 or the age of 10. To have many children in a family survive to the age of 20 was not a usual condition, so there was a kind of fatalism among the population and the ways in which they accepted that many of their children might not survive. This, too, was a fact of life that has radically changed for us in the late 20th century.

Now, despite the fact that widespread epidemic outbreaks in New York City were really relatively minor contributions to the overall death rates, the problem is that these epidemics were highly visible and dramatic experiences where inhabitants of the city often saw people literally dying in the streets. And it had an enormous impact on the psychological feelings of people who lived in this city at the time. The rich, when these diseases would occur, often fled to the countryside when epidemics broke out. Others simply moved further and further away from whatever parts of the city the diseases had appeared. So many people who lived near the downtown tenement house districts would just move uptown. Others would move out of the city altogether.